People’s lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics. Incidents as varied as automobile accidents, heart attacks, slips and falls, childbirth, and gunshot wounds all require immediate medical attention. EMTs and paramedics provide this vital service as they care for and transport the sick or injured to a medical facility.

In an emergency, EMTs and paramedics are typically dispatched by a 911 operator to the scene, where they often work with police and fire fighters. (Police and detectives and firefighting occupations are discussed elsewhere in the Handbook.) Once they arrive, EMTs and paramedics assess the nature of the patient’s condition while trying to determine whether the patient has any pre-existing medical conditions. Following medical protocols and guidelines, they provide appropriate emergency care and, when necessary, transport the patient. Some paramedics are trained to treat patients with minor injuries on the scene of an accident or they may treat them at their home without transporting them to a medical facility. Emergency treatment is carried out under the medical direction of physicians.

EMTs and paramedics may use special equipment, such as backboards, to immobilize patients before placing them on stretchers and securing them in the ambulance for transport to a medical facility. These workers generally work in teams. During the transport of a patient, one EMT or paramedic drives while the other monitors the patient’s vital signs and gives additional care as needed. Some paramedics work as part of a helicopter’s flight crew to transport critically ill or injured patients to hospital trauma centers.

At the medical facility, EMTs and paramedics help transfer patients to the emergency department, report their observations and actions to emergency department staff, and may provide additional emergency treatment. After each run, EMTs and paramedics replace used supplies and check equipment. If a transported patient had a contagious disease, EMTs and paramedics decontaminate the interior of the ambulance and report cases to the proper authorities.

EMTs and paramedics also provide transportation for patients from one medical facility to another, particularly if they work for private ambulance services. Patients often need to be transferred to a hospital that specializes in their injury or illness or to a nursing home.

Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. The National Registry of Emergency Medical Technicians (NREMT) certifies emergency medical service providers at five levels: First Responder; EMT-Basic; EMT-Intermediate, which has two levels called 1985 and 1999; and Paramedic. Some States, however, have their own certification programs and use distinct names and titles.

The EMT-Basic represents the first component of the emergency medical technician system. An EMT trained at this level is prepared to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under medical direction. The EMT-Basic has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies.

The EMT-Intermediate has more advanced training. However, the specific tasks that those certified at this level are allowed to perform varies greatly from State to State.

EMT-Paramedics provide the most extensive pre-hospital care. In addition to carrying out the procedures of the other levels, paramedics may administer drugs orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment. However, like EMT-Intermediate, what paramedics are permitted to do varies by State.